Active NPI
Omeir Tariq Ansari, DDS
- Dentist
- Lake Mary, FL
National Provider Identifier
1891337366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 24485
- Practice address
- 3779 Lake Emma Rd
Lake Mary, FL 32746-6156 - Phone
- (407) 547-1359
- NPI assigned
- Oct 16, 2019
- Last updated
- Oct 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 24485 | FL | Primary |
Addresses
Primary practice location
3779 Lake Emma Rd
Lake Mary, FL 32746-6156
Mailing address
5305 Hawk Dr
Kissimmee, FL 34746
Phone (407) 749-9656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200122000933 | FL | Order and Referring Only - Dentist | 3577998574 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24485 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Mary Modern Dentistry, PA | Dentist | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571184000000",
"number": "1891337366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5305 HAWK DR",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "34746",
"telephone_number": "407-749-9656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3779 LAKE EMMA RD",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327466156",
"telephone_number": "407-547-1359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANSARI",
"first_name": "OMEIR",
"middle_name": "TARIQ",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-16",
"last_updated": "2019-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "24485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.